A PARADIGM SHIFT IN THE EDUCATION OF HEALTH PROFESSIONALS IN
EXERCISE MEDICINE & THE PREVENTION AND TREATMENT OF NON
COMMUNICABLE DISEASES
FACULTY OF SPORTS & EXERCISE MEDICINE
THE ROYAL COLLEGE OF PHY SICIANS, LONDON. JUN E 2014
BACKGROUND
The World Health Organization (WHO) is tasked with reducing death from cardiovascular disease,
cancer, diabetes and chronic respiratory disease by 25% by 2025: these are known as the “25 by25”
goals. The World Heart Federation (WHF) is also tasked to work with nations and member
organisations to focus on delivering a 25% reduction in premature mortality from cardiovascular
disease (CVD) by 2025. The British government signed up to delivering the 25x25 goals in 2011.
This year, the WHF initiated an ambitious global project to recruit 25 ‘disruptive innovators’ from 16
nations around the world. I am proud to be one of those emerging leaders, and to represent Great
Britain on the WHF Emerging Leaders Programme.
One of the nine key WHF goals is to reduce physical inactivity by 10% by 2025. This is an opportunity
not only to influence a reduction in heart disease and stroke but also to significantly affect a reduction
in risk from other non-communicable diseases (NCDs) such as cancer, Type 2 diabetes and obesity.
This goal is not only about prevention but is also about the treatment of chronic disease conditions
with exercise, as a medicine. Within the context of undergraduate and post-graduate education &
training proposals put forward as part of this assignment, please note that all NCDs and exercise
medicine are to be included, not just CVD.
The All Parliamentary Commission on Physical Activity (2014) clearly identified opportunities for
health professionals to provide “teachable moments” to patients on their ‘cradle to grave’ pathways
through the National Health Service (NHS) system. These teachable moments are defined as brief
physical activity advice, within a consult, that ensures that the health professional ‘makes every
contact count’.
Making Every Contact Count (MECC 2011) is the key to the whole paradigm shift in access to
exercise medicine for patients. It is this strategic mechanism that directs every health professional
(both in primary and secondary care) to support each and every patient in the UK, to meet the CMO
physical activity guidelines. However, these “teachable moments” require health professionals to be
trained to give ‘safe and effective’ exercise support and advice, every consult. So to achieve the WHO
and WHF goal of reducing physical inactivity, we must first train the health care professionals to
provide physical activity advice. This advice needs to be effective both for short and long term patient
goals and within the time constraints of the consultation with the health professional. Guidance for
primary care health professionals in the UK on how to do this was issued by the National Institute of
Health and Care Excellence (NICE PH44) in 2013, but this guidance fails to cover the important
provision and potential of “teachable moments” in secondary and tertiary care. It also only covers
post-graduate training possibilities. However, if training was provided at both the undergraduate and
post graduate level then patients in both primary and secondary care would receive this quality
advice, by 100% of the NHS workforce. This, within an existing multi-disciplinary approach would add
significant extra value to existing patient care. This comprehensive and educationally consistent
approach to health professional training on exercise medicine would ensure a cultural shift across the
NHS in terms of delivering the MECC agenda. It will also drive a strategic vision to designing
educational courses to ensure that all areas of the NHS workforce are ‘fit for purpose’ to deliver
physical activity support.
ANN GATES
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ASSIGNMENT AIMS
There are 3 strategic aims of this assignment. To:
1. identify, develop and deliver training to all allied health professionals and outreach workers to
provide effective physical activity advice and support to every patient, every consult.
2. identify, develop and deliver training to all surgeons and their MDT’s, in all fields, to provide
effective physical activity advice and support to every pre- and post-operative patient, every
consult.
3. identify, develop and deliver training to all physicians and general practitioners to provide
effective physical activity advice and support to every patient, every consult.
These aims incorporate and underpin all aspects of undergraduate, postgraduate, and continuous
medical education (CME) and professional development training required to deliver the MECC & the
physical activity agenda. They also provides a unique opportunity for all health professionals to fully
understand the complexities of how health, disease, lifestyle choices and genes interact during their
training and practice.
GLOBAL VISION AND AMBITION
To achieve this for Great Britain would be remarkable but here is an opportunity for the medical and
health bodies in Great Britain to lead the world on providing a detailed strategic plan on delivering the
project aims. The global networks offered by the WHF together with the Royal Colleges network of
professionals could create a ‘tipping point’ moment in the way in which we teach and practice
exercise medicine. This would indeed establish MECC as a conduit for successful physical activity
interventions and promote Great Britain on leading the way on NCD management with exercise
medicine.
DISCUSSION AND RECOM MENDATIONS
The strategic detail required to ensure these strategic aims are met, is fully recognised. No one
person or medical body has been able to strategically influence the training of health professionals in
this way before. I know this is a huge undertaking for the Faculty and Royal Colleges- but no one ever
said that achieving a cultural and seismic shift in medicine was easy! We are all aware of the
extensive evidence supporting exercise as a medicine. We are all aware of the need to train our
undergraduates. However, what this proposal adds in value is a comprehensive, “no gaps” approach
to strategic delivery at the patient level. To focus on just undergraduate training in exercise medicine
loses the potential to provide complete coverage for “teachable moments,” every contact. To include
post graduate courses and training to all health professionals offers both the Faculty and other health
bodies the opportunities to enrich qualified professional’s knowledge, practice and successful consults
in a way that embodies the purpose of MECC. From a patients perspective it guarantees, that
whatever disease, whichever health professional they interact with, they can rely on receiving
quality exercise advice, support, signposting and improved health outcomes.
OPTION APPRAISAL
Four potential strategic options are available and are summarised in Table 1.
SUMMARY
The WHF Emerging Leaders Programme, has provided the catalyst for a paradigm shift in the way we
train NHS health professionals to be ‘fit for purpose’ to deliver on the physical inactivity agenda and
the 25x25 goals. A comprehensive strategy to train health professionals in exercise medicine, is now
urgent, crucial, and would provide the framework to make every contact count, for physical activity.
ANN GATES
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BIBLIOGRAPHY & CONTEXT
World Health Organization (WHO) 2011 Political Declaration on Noncommunicable Diseases (NCDs) adopted by the UN General Assembly in 2011.
WHO developed a global monitoring framework to enable global tracking of progress
in preventing and controlling major non-communicable diseases - cardiovascular
disease, cancer, chronic lung diseases and diabetes - and their key risk factors:
http://www.who.int/nmh/global_monitoring_framework/en/
World Heart Federation 2014 media brief for the 25x25 goals: http://www.worldheart-federation.org/fileadmin/user_upload/Congress/WCC2014/BACKGROUNDER25x25_-FINAL.pdf
World Heart Federation Champion Advocate Programme 2013
http://www.championadvocates.org/en
World Heart Federation Emerging Leaders Programme 2014
http://www.championadvocates.org/en/emerging-leaders
Overview by The Lancet 2014, by Robert Beaglehole, Ruth Bonita and Richard
Horton on the UK sign up to delivering the 25x25 goals:
http://nhfshare.heartforum.org.uk/RMAssets/LancetSeries4/Document5.pdf
All Parliamentary Commission on Physical Activity 2014
http://parliamentarycommissiononphysicalactivity.files.wordpress.com/2014/04/apco
pa-final.pdf
Making Every Contact Count (MECC) 2011
http://www.healthyambitions.co.uk/Uploads/BetterForLess/08%20BETTER%20FOR
%20LESS%20every%20contact%20counts.pdf
Chief Medical Officers 2011 UK Physical Activity Guidelines
https://www.gov.uk/government/publications/uk-physical-activity-guidelines
National Institute of Health and Care Excellence (NICE) 2013: Physical activity:
brief advice for adults in primary care (PH44) http://www.nice.org.uk/PH44
Tipping point definition: http://en.wikipedia.org/wiki/Tipping_point_(sociology)
For more information on the effect of physical inactivity on major non-communicable
diseases worldwide: an analysis of burden of disease and life expectancy please see
the Lancet Physical Activity Series Working Group, I-Min et al:
http://www.thelancet.com/series/physical-activity
ANN GATES
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